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Authors: Kate Richards

Madness (17 page)

BOOK: Madness
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‘Wonderful,' she says. ‘When are you going to see your doctor to discuss how to take this drug properly?'

‘Ah . . .'

‘What is the appropriate dose? How often should you take it?'

‘I've done the research, I've read MIMS and the journals and the professional websites.'

‘You must talk to an objective clinician. You of all people know the dangers of self-medication. And medication is not my area of expertise. Please make an appointment with Jenny this week.'

Winsome is a qualified counselling psychologist. This means she works with people experiencing problems in relationships, within family units and in times of great stress like bereavement and divorce. She provides psychotherapy for people with depression and anxiety but medication for serious mental illness is the domain of general medical practitioners like Jenny and psychiatrists.

Jenny listens while I explain how the slowly increasing dose of Pericyazine has had a linear, inverse relationship to the shouting in my head. We discuss side effects and agree on an appropriate dose.

‘This is terrific,' she says, writing me a prescription. ‘Keep going with it.'

For several months, I sleep twelve to fourteen hours straight. I'm obsessed with the concept of a regular, easy period of night-unconsciousness. I'm not sure, but I think my brain might be healing itself.

During the day, the process of thinking is untainted, uninfected; rather it is sequential and fluid. I have a capacity for learning new things; I'm interested in things. The fog . . . the turgid white fog has gone. I'm aware of my body – chest wall when I breathe, pectorals, biceps, finger bones. I'm also aware of people in the street, the smell of the air and the feel of the sun. There is room in my head, depths and hollows. I echo. Thinking takes up a different time and space so that it is as easy to get lost in it as within a deep cave; the dark vanishing somewhere overhead.

A friend from university and I go out for coffee and his voice is clear, in both annunciation and meaning. All of me is listening to him, absorbing him, all of me is right here in this cafe where his hair is reflecting the sun like water.

‘It's bizarre,' I say. ‘I can hear every word you say. I mean, I'm sure I always could, there's nothing wrong with my hearing, but I used to process every second or third word, or sometimes I'd only catch the very end of a sentence, because there'd be blah blah blah at the same time, and so I'd nod and smile and try to look like I understood and, oh God, just hope that the other person didn't notice.'

He sighs and shakes his head. ‘Bloody hell.'

‘Yeah. But I think I now understand what Thich Nhat Hanh means by being in the present moment.'

‘My brother met Hanh once, at his sangha in France.'

‘Really? I'd probably swoon on the spot. And then die of embarrassment.'

We laugh.

The palm trees along Jacka Parade are ruffling in the wind. ‘I know it's not a cure,' I say quietly. ‘I mean, I'm still dysfunctional. Just not, you know . . .
mad
and dysfunctional.'

Pericyazine 2.5 mg and 10 mg tablets. Pale yellow and white. 25 tablets in each blister pack. Four blister packs in every box. One hundred Pills For Sanity at $14.45 or $3.95 concession.

The dreadful urge to mutilate my body . . . vanishes that way thirst does after receiving water or a burning itch is soothed. The scars turn from red, raised and angry to finer white, and like lines or paths, they tell their own stories. Sensation to the skin isn't returning however, and hair grows only between patches of injury.

‘I haven't existed properly, in this body,' I say to Winsome. ‘Not for a long time.'

She nods.

‘Feeling,' I touch my fingertips together. ‘Flesh. A beginning. Is it? Does it?'

‘What?'

‘Bring connectedness. Between me, as in my mind, and the world.'

‘Your body? Yes.'

‘Hah. It's taken me awhile. What's this, about age two in the realm of developmental psychology?'

Winsome smiles. ‘Two or three.'

‘It was okay once. And then I lost it.'

‘I suspect you are right.'

‘So it occurs to me that my once carefully constructed reality is, in fact, false – I mean, to the point of being delusional.'

‘Yes,' she says.

‘So maybe I do have a mental illness.

Fuck that hurts.

Winsome sits quietly. Then she says, ‘This is a breakthrough for you.'

I wave my hands – comme ci comme ça. ‘I'm still uneasy. About taking a drug that alters my brain . . . I mean, alters the way I think, what I think, how I respond to the world. It's a weird concept.' I scrunch up my eyes, rub my forehead hard. ‘And Rose and Henry have left so I'm a bit bereft.'

‘Rose and Henry?'

‘Oh, you know, my companions of a sort. They loved each other. In here,' I tap the side of my head with my index finger.

There's an article in the paper today about volunteer-fostering very new kittens and sick or abused cats from a local animal shelter. I apply, go for an interview, pass a police check, attend a training session with other feline-centric people. My first foster cats are a pair of young adult brothers, all white and terrified of everything, especially me. They sit rod-still in their carry-box, eyes black pupil with the thinnest yellow rim. I set up their food and water and litter in the bathroom and line the bath with thick, soft blankets, tip the carry-box onto its side and ease them out. They're thin and shivering. They hiss and stick their claws into the back of my hands. They bite.

‘It's okay, young ones. It's okay now.'

I leave them for the evening but every night after work, I sit in the other end of the bath with a book and a glass of wine. We sit for hours, none of us moving, just checking each other out. Their stiff crouches ease. One cat yawns. One white paw stretches in my direction. Two.

I smile.

Then the phone rings; the moth-soft paws retract. I go out to answer the phone and when I get back, both cats are over my side of the bath.

‘Boys, what are you doing?'

Two white heads, wet whiskers. Between them they've lapped up half a glass of white wine. The cats settle back in their corner.

‘No more wine. Is that clear?'

They stare. Silent. Candle-flame eyes.

There is so much about the functioning of the brain that we still don't understand. This is true for neurological function and psychological function and for the delicate connections between the two.

A study of 3300 UK adults born in 1946 who had a psychiatric examination at age 36 were then followed up until the age of 60. The results, published in 2011, showed that individuals diagnosed with a psychiatric disorder had an 84 per cent higher chance of dying before the age of 60 than those without. The increase was not accounted for by suicide, physical health or socio-economic factors. ‘It is remarkable,' the authors wrote, that an interview on mood and thinking administered as a one off test at 36 years of age ‘appears to impact on mortality more than two decades later.' Why? The reasons remain unclear.

But Mental Health is not sexy. Pharmaceutical companies fund very little research in the field of mental health in comparison with their investments in cancer, kids and cardiovascular disease.

Professor of Psychiatry at Monash University, Jayashri Kulkarni says, ‘there is one big piece of the jigsaw puzzle that still seems to be missing in Australia's commitment to mental health: investment in clinical mental health research. Despite the raw facts – mental illness is the third-highest cause of disability and premature death in Australia and one in four of us will experience mental illness in our lifetime – only 3.5 per cent of Australia's total medical research budget is spent on research into depression and psychosis.'

There's a small, relatively new centre of psychiatry research in Melbourne and I ring to see if I'm eligible to participate in one of their clinical trials. Over the next 18 months I take part in three studies. One is an observational exploration of treatments and outcomes in people with a history of bipolar or schizoaffective disorder.

Baseline results show that half of the 240 participants smoke daily, less than half are in a stable relationship, over a third are unemployed and two thirds contemplated suicide in the month prior to entering the study. Like me, there is an average seven-year gap between first onset of symptoms and first medical treatment. That's seven years of confusion and problematic mood swings and periodic terror.

Hopefully the field of neuropsychiatry will continue to expand with advances in imaging of the structure and function of the brain. In time, it may be possible to identify genes or critical DNA variants, patterns of electrical activity, neurotransmitter levels or neuroanatomical abnormalities that confer susceptibility to illnesses such as schizophrenia and bipolar disorder.

Such tests could immediately identify individuals at risk and be a useful adjunct to diagnosis. For example it is now clear, ‘that dopamine dysfunction is the final common pathway to developing psychotic symptoms,' says Professor Sir Robin Murray, from the Institute of Psychiatry at King's College London. Dopamine is one of the brain's neurotransmitters that effects communication between neurones (brain cells).

With regard to schizophrenia, Professor Murray says ‘Excessive dopamine leads to salience being attached to ideas and objects that are, in fact, unimportant. The number of red cars that you passed on the way to work, or the fact that two people coughed at the same time, takes on new meanings.'

One day we may have very specific, molecularly targeted treatments for mental illness similar to those already in use for cancer. Compliance with current medication regimes is a real problem because of intolerable side effects. Research into psychosocial interventions including supportive care and psychotherapy remains equally valuable.

‘The important thing,' says Professor Kulkarni ‘is to find what works.'

Zoë is terribly sick. Like Naava and myself, she has battled more than one episode of severe depression before adulthood.

‘It sits in the back of my mind all the time, you know?' she says.

Saturday nights the three of us are lounging on couches at my place or hers for food and wine and honesty.

‘No matter where I am or what I'm doing, it's always there. It's in my dreams.'

We know.

The thoughts that give no peace. And the ache. The grief that is not really grief. The damn endless, endless misery.

Suicide.

‘Are you getting any sleep?' Naava asks.

‘Three or four hours.'

‘Shit.' We say it together.

‘But I didn't actually get out of bed till four this afternoon,' Zoë says. ‘And I'm more exhausted in the mornings than I am in the evenings.'

She's subsisting on chocolate and nicotine, self-medication of sorts. She has a wonderful psychologist and a supportive doctor, but severe depression locks the mind in a scold's bridle. It's an unreachable despair.

One evening Zoë rings from an Emergency Department.

‘I um . . . I cut myself,' she says. ‘I'll be home soon. Can you come over?'

I do and we hug in the hallway and I wish I could transmit more than physical warmth.

‘What's happening, honey?' I ask.

We sit close together on her couch. She doesn't answer for a long time.

She says, ‘I hate feeling like absolute shit every single fucking day. It's HELL.'

Keep quiet and calm. Quiet and calm. Don't cry. ‘Oh Jesus,' I say softly. ‘I'm so sorry.'

Quiet and calm. Don't cry.

‘I can't keep going like this,' she says.

Tears run down my face over my chin and drip onto my t-shirt.

‘Please,' I say. ‘We can get through this.'

She shakes her head.

‘I love you,' I say.

‘I'm sorry.'

We both cry harder.

‘He was an arsehole,' she says after a while, eyes on the floor.

‘Who?'

‘He treated me – not like an animal – more like a slab of meat.'

‘Who did?'

‘The emergency doctor.'

‘What happened?'

‘First I waited for three hours. I know I didn't have a life-threatening emergency, I know that, but it was bloody hard to sit there with all these people and not completely freak out.'

‘Three hours.'

‘Yep. Then they put me in the procedure room and just left me, with boxes of scalpels and needles and whatever else and they knew I was there because of self-harm.'

‘You're fucking kidding.'

‘Then the doctor came in.'

Zoë stares at the floor. Not blinking, not crying anymore. I fold my hands to keep them still and wait.

‘He hardly said a word to me,' she says. ‘He didn't even wait for the local anaesthetic to kick in, he just started suturing and when I said, excuse me, it's really hurting, he mumbled something like, well it must have hurt to do it in the first place. Like he was punishing me.'

I look at her wounds. Deep red cries. Deep red pain. The stitches are uneven – some tight, some loose – and they're too far apart. It's a shoddy job. I try adding some steri-strips so the wounds won't reopen before her own doctor can review them tomorrow. There's an engineer's vice in the centre of my chest and it's crushing my heart on both sides.

‘How're you doing?' I ask her later.

‘Scared shitless. How're you doing?'

‘Scared shitless.'

The following week, Zoë's doctor goes on holiday and Zoë again requires stitches for deep cuts to her legs and belly. She is drifting further away from us, closing down, her voice is low and flat, her face, her eyes . . . her eyes were like that first touch of sunlight through clear, deep water. Now they are grey.

When the thoughts of suicide are absolute and unshakeable, she makes an appointment to see her doctor's covering clinician. He refuses to admit her to the clinic where she's been an inpatient before, where she has some connection with the staff and the place itself. In his learned opinion, the hospital environment is counterproductive for some people. After reviewing Zoë once, for fifteen minutes, he decides she is one of those people.

If I were in any way inclined to violence . . .

We try to make an appointment to see my GP, Jenny, who is also on holiday. Her covering clinician listens carefully and rings the intake co-ordinators of all the private psychiatric hospitals in Melbourne. There are no beds available. We sit in the waiting room while she sees other patients. Then we go back in and she tries the public units. There are no beds available.

‘What are we going to do?' I ask.

‘I'm so sorry,' she says. ‘Come back and see me tomorrow and we'll try again.'

The three of us hunch up on the couch at my place with comfort food and vodka. We're not hungry. Naava and I wait till Zoë has taken her medication – antidepressants and a sleeping tablet. When she's drowsy, Naava and I take our own medication and we all get into my bed. The cats curl up with us.

At 5 a.m. there's just a hint of light through the window and I can see Zoë's chest rising and falling as she breathes. She's breathing too slowly.

‘‘Zoë, are you okay?' I shake her gently. Naava is awake now.

‘Is she okay?' she asks.

‘No.'

I ring triple zero. ‘My friend has taken an overdose sometime in the night, I think. She's breathing, but she's unconscious.'

While we wait for the ambulance, the operator says, ‘Count out her pulse for me.'

‘One, two, three . . .'

‘Now count out her breaths.'

‘One . . . two . . .'

The paramedics arrive and they insert an oro-pharyngeal tube to help with her breathing and give her some high flow oxygen and I sit next to the driver and we travel with lights and sirens to the hospital. Once there, Naava and I are ushered into ‘the relatives room.' I know this room – it's where they put people whose loved ones are either critically ill or already dead. Soft lighting, a telephone, a box of tissues. Naava and I don't speak. Everything is blurry. One of the emergency physicians comes in.

‘She's going to be okay,' he says.

I feel like a block of ice receiving the sun.

‘We've had to intubate her so she'll be in intensive care for a few days.'

I ring Zoë's family, who are interstate but will get on a plane immediately. At home I sit on the front steps. It is raining. Light is lavishing sheen onto a puddle of water at my feet. Water falling several millilitres at a time into water. Water responding with wavelets, rings, circles that are, in spite of everything, radiating and concentric and perfect. Then I go inside and lie down and howl.

When we visit the next day, Zoë is awake. I reach for both her hands, holding them in mine, so tight. Not letting go. We sit here, not moving. The cubicle curtains shift as people walk past. Someone's mobile rings out hip-hop. My left hand cramps, Zoë's hands, inside mine, are turning dark red-blue. We sit here, not moving. Then she looks at me and at my eyes that are saying the same thing as my hands and if I could only transplant into her – so that she believed it – the preciousness of her life.

Why does it so often take a serious act of harm to self or others before someone is deemed sick enough to be admitted to hospital?

‘I don't understand,' I say to Zoë's parents. They are looking shattered. Zoë spends the next eight weeks in the clinic from which she was previously refused admission. On discharge she's somewhat stable, but it's many months for her, I think, before the idea of death is unreservedly supplanted by the idea of living.

The Australian Institute for Patient and Family Centred Care notes that, ‘A patient is more than an aggregate of physical symptoms that need medicating or hospitalising but rather is someone who has strengths, expertise and resources. Acknowledging and tapping into these can empower both the patient and the health professional.'

This is true for all fields of medicine, including psychiatry and mental health. We need to move beyond the ‘static model of doctor as giver, patient as receiver' and instead develop partnerships between patients, their families, carers and health professionals.

When someone is seriously mentally ill and unable to give a clear description of symptoms, family and carers are in the best position to provide health workers with information that is potentially lifesaving. I've spoken with many families and carers who are immensely frustrated that they are not heard or believed or taken seriously when they report that their loved one is becoming unwell and needs assessment and treatment. They know the patient best. They know what is usual and what is not and what is indicative of illness and relapse.

Patients also have skills and strengths. It hurts not to be respected or treated with dignity. Every human being has the same kind of heart. The same kinds of fears. The same need for connection.

BOOK: Madness
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